The Transplant Race

Summary

Cardiac Cowboys – Episode 4: The Transplant Race

Host: Chris Pine
Date: September 29, 2025
Presented by: iHeartPodcasts
Writer/Producer: Jamie Napoli

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Episode Overview

This episode, titled "The Transplant Race," chronicles the dramatic and emotional race to achieve the world’s first successful human heart transplant during the 1960s. It explores the obsessive ambitions, rivalries, and innovations of surgeons in the U.S. Midwest, Texas, and ultimately South Africa, highlighting the personal and professional stakes for those involved. The story centers on Christian Barnard’s historic first transplant in Cape Town, the global response, and the subsequent challenges that heart transplantation faced in its infancy.

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Key Discussion Points and Insights

1. The “Moonshot” of Heart Surgery (00:35–03:05)

• Chris Pine opens by drawing parallels between the 1960s heart transplant drive and the era’s broader spirit of daring exploration, likening it to the moonshot.

• Quote:
  “We choose to go to the moon in this decade and do the other things... because they are hard.” (01:28 – Various voices echoing Kennedy's famous words)

• Dr. Norman Shumway of Stanford University emerges as the leading American contender, announcing he is ready for a human heart transplant—if he can secure the right donor and recipient.

• This public declaration “lit a fire” under other surgeons worldwide.

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2. The American Heart Disease Crisis and the Call for Transplantation (03:05–05:05)

• By the 1950s, heart disease had become an American epidemic, partially due to sedentary lifestyles, smoking, and dietary habits.
• Surgeons like Walt Lillehei and Earl Bakken had already pushed technical boundaries with devices like the pacemaker.
• Transplantation was seen as the next logical—and life-saving—step.

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3. The Global Field of Contenders (05:05–06:42)

• Not just Shumway, but also Dr. Adrian Cantrowitz in Brooklyn and Dr. James Hardy in Mississippi—who infamously attempted a transplant with a chimpanzee heart—were racing to be first.
• Major advances in cardiac surgery were coming not from elite East Coast institutions but from ambitious outsiders and under-resourced teams.
• The world’s fascination with the heart was as much emotional as medical.

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4. The Shock of Barnard’s Win (06:42–07:55)

• Christian Barnard, a relatively unknown South African surgeon, beats the American frontrunners to conduct the first successful human heart transplant on December 3, 1967.
• Quote:
  “Some joker down in Africa has done a heart transplant.” (06:30 – A surgeon’s shocked reaction)
• Overnight, Barnard becomes a global celebrity.

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5. Barnard’s Unlikely Path (07:55–11:26)

• Barnard’s childhood in poverty, his family’s anti-apartheid stance, and the loss of a brother to congenital heart disease shaped his ethos.

• Cindy Ladigan (Heart of Cape Town Museum):
  “When he brought intensive care to South Africa... He had this attitude of if you didn’t like it, you could go die at home.” (09:26)

• Fierce maternal expectations and trauma from family tragedy drove Barnard's relentless striving.

• He scraped together scholarships for medical school and became known for his grit and charisma.

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6. Barnard’s Training and Crucible in America (11:26–15:10)

• Recruited to study in Minnesota with famed surgeons like Walt Lillehei and Owen Wangenstein, Barnard excelled in research and learned pioneering cardiac techniques.

• Adam Barnard (nephew):
  “He could make you feel a million dollars in two seconds. But he could also make you feel the biggest fool in two seconds.” (13:34)

• Barnard’s surgical confidence was shaken after he made a fatal mistake on a young patient, but Lillehei’s mentorship shaped his resilience.

• Dr. Craig Lillehei:
  “Good judgment comes from experience and experience comes from bad judgment.” (17:03)

7. Shumway Versus Barnard: Contrasts and Rivalries (15:10–20:03)

• Norman Shumway’s quiet, self-deprecating style contrasted with Barnard’s flair.
• Dr. Sarah Shumway (Norm’s daughter):
  “He told me... to keep things light so people didn't get too overwhelmed by the fact they were cutting out people's hearts.” (18:53)
• Both men returned to their home institutions, each determined to be first.

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8. Overcoming Technical and Ethical Obstacles (20:25–26:34)

• Back in Cape Town with new equipment, Barnard faced his own “ticking clock” due to rheumatoid arthritis.
• Shumway struggled with the lack of viable donors—surgeons still needed to redefine “death” around brain activity and not heartbeat.
• Norm Shumway:
  “Even our neurosurgeons were very slow to come to grips with brain death.... This was a difficult problem.” (24:17)
• Immunosuppression (preventing rejection) was another enormous challenge.
• Barnard’s visit to the U.S. enabled him to adopt American techniques for transplantation, further stoking controversy.

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9. The Night It Happened: Barnard’s Operation (27:58–36:32)

• The tragic accident that killed Denise Darvall provided the right donor at the right time for Louis Washkansky, a critically ill patient.
• Edward Darvall’s decision:
  “If you cannot save the life of my daughter, then you need to save the life of that man.” (33:11)
• The technical details and emotional high stakes of the transplant procedure are vividly described.
• Christian Barnard (archive):
  “When I left the hospital that morning... not one photographer, not one television camera... I said... we better tell someone in the hospital that we’ve done a heart transplant tonight.” (36:42)

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10. Aftermath and Ripple Effects (36:56–45:53)

• News spreads worldwide; Barnard becomes a celebrity, but resentment and rivalry simmer.
• Denton Cooley (telegram):
  “Congratulations on your first heart transplant, Chris. I will soon be doing my 100th.” (37:48)
• Norm Shumway’s daughter:
  “Dad seemed to be quite excited that a transplant had been performed... I think that wasn't the prize he was after.” (38:43)
• Barnard’s operation legitimized brain death as a criterion for organ donation.
• Heart transplants sweep the globe, but early results are sobering—most recipients die within months.
• Barnard endures both adulation and vilification.

11. The Surgeons Become Astronauts of Medicine (41:41–45:53)

• Denton Cooley:
  “You feel like you're something like an astronaut, you know ... In those early events, we were, I think, glorified beyond reason.” (41:41)

• Despite initial successes, a backlash forms as early transplants mostly fail; heart swapping is equated to “direct killing.”

• Cindy Ladigan:
  “People that were asking for his earlier race because he should be had up for murder. People that said he was unmoral and a bunch of ghouls.” (45:38)

• The “fever breaks” and transplant surgery faces an existential threat.

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Notable Quotes and Memorable Moments

• On the spirit of 1960s innovation:
  “We choose to go to the moon in this decade and do the other things... because that challenge is one that we’re willing to accept.” (01:32 – various voices)

• On the motivations behind heart transplantation:
  “The American dream was killing us. For patients whose hearts were damaged beyond repair, a transplant was the only hope for survival.” (04:01 – Chris Pine)

• On losing the transplant dash:
  “Some joker down in Africa has done a heart transplant.” (06:30 – American surgeon, recounting the surprise)

• On the emotional cost of failure:
  “He lay on the couch there and... was crying because he was a very likable man, Mr. Wishkansky... It was great sorrow that we let him down.” (39:46 – Dr. Christian Barnard)

• On fame as a double-edged sword:
  “Fame is quite a lethal drug. My father used to say that the worst drug in the world is somebody claps hands at you because it goes to your head, you know. That did unfortunately get to my uncle.” (43:27 – Adam Barnard)

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Timestamps to Key Segments

• 00:35 — Introduction: The "moonshot" of heart surgery; Norm Shumway’s announcement
• 03:05 — The American heart disease crisis and need for cardiac innovation
• 05:05 — The list of global contenders in the “transplant race”
• 06:42 — Christian Barnard conducts the first human heart transplant
• 07:55 — Christian Barnard’s early life and motivations
• 11:26 — Barnard’s Minnesota training and traumatic OR experience
• 15:10 — Contrasting approaches of Barnard and Shumway; rivalry
• 20:25 — Barnard's return to Cape Town with new skills and urgency
• 23:19 — Shumway’s technical and ethical obstacles
• 27:58 — The events leading up to, and the night of, the transplant
• 36:32 — Aftermath: The media storm and global reaction
• 41:41 — “Medical astronauts” and the rise (and fall) of transplant fever
• 45:14 — Backlash, failures, and heart transplants "on trial"
• 46:27 — Teaser for next episode: mechanical hearts and feuding Texas legend

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Conclusion

"The Transplant Race" delivers a dramatic, highly personal account of how ambition, circumstance, and sheer will brought about the first heart transplant, while also capturing the cost—ethical, emotional, and scientific—of such groundbreaking work. The episode deftly illustrates that behind every celebrated “first” in medicine are dozens of unsung heroes, fateful coincidences, bitter rivalries, and moments of deep human vulnerability.

Next Episode Tease: The rise of the artificial heart—and the feud between DeBakey and Cooley.

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Transcript

[Cindy Ladigan]

This is an iHeart podcast.

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[Chris Pine]

Welcome to the Wild west of American Medicine. I'm Chris Pine and this is Cardiac Cowboys, the gripping true story behind the birth of open heart surgery and the maverick surgeons who made it happen. It's 1967, 12 years since Walt Lillehei first used his bubble oxygenator to repair a child's heart defect. In over nine years since Lillehei and Earl Bakken developed the portable pacemaker, we're more than halfway through a decade defined by social unrest and the righting of wrongs, by the nightmare of nuclear war and the dream of new frontiers.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

We choose to go to the moon in this decade and do the other things.

[Jamie Napoli]

Not because they are easy, but because they are hard.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Because that goes will serve to organize and measure the best of our energies and skills. Because that challenge is one that we're willing to accept.

[Chris Pine]

In Palo Alto, California, a young doctor sits for an interview with the Journal of the American Medical Association. His casual dress and self deprecating manner feel more suited to a liberal arts professor than one of the world's leading cardiac surgeons. This is Dr. Norman Shumway and he's about to make an announcement that will send shockwaves around the world. After training under Walt Lillehei at the University of Minnesota, Shumway has spent the last several years working toward a moonshot within the field of cardiac medicine. It's an operation long considered impossible. Transplanting the human heart. He and his team at Stanford University have been experimenting with anti rejection drugs and performing test operations on lab animals. Today, Shumway announces that he's ready for the real thing. All he needs now is the right patient and a matching donor. When this interview is published on November 20, it will light a fire under all the other surgeons working around the world to beat Shumway to the punch. The heart transplant race is on.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Really, the heart disease crisis was about adult heart disease.

[Chris Pine]

That's cardiologist Dr. J. Phillips, Saul. Much of our story until this point is focused on congenital heart defects in kids. But the cardiac crisis Was far from limited to children. By the 1950s, heart disease was killing over half a million Americans every year. I say Americans because the problem seemed to be uniquely targeting this country, the richest in the world, where people were living increasingly sedentary lives. Commuting by car or train, working long hours at a desk, smoking cigarettes, and eating high fat diets, Hamburger steak and lamb chops.

[Jamie Napoli]

You can almost track and parallel the.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Rise in both heart disease and lung cancer. Starting about 20 years after the invention of the cigarette machine, Cigarettes began to.

[Chris Pine]

Be produced in much greater quantity. That almost single handedly explains a huge amount of the heart disease, red meat, cars and cigarettes. The American dream was killing us. For patients whose hearts were damaged beyond repair, A transplant was the only hope for survival. Thanks to the experiments conducted by Shumway and his partner, Richard LAUER, by the 1960s, human heart transplantation was beginning to feel less like science fiction and more like an attainable reality. But Shumway and Lauer weren't the only contenders in the transplant race. In Brooklyn, there was Dr. Adrian Cantrowitz, a brilliant and burly surgeon inventor who ran the cardiovascular surgery department at Maimonides hospital.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Heart surgeons who were capable of doing this kind of surgery seemed invincible. And that kind of aura was important to win the confidence of the patient.

[Chris Pine]

In jackson, Mississippi, there was Dr. James D. Hardy. As chairman of the University of Mississippi's surgical department, Hardy courted controversy when he attempted the first human heart transplant back in 1964. The operation did not succeed, but most of the criticism focused on the fact that the donor heart was taken not from another human, but from a chimpanzee.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Once that heart has been removed, then one is looking at a hole in the chest, Then something's got to be put there or one is going to have to talk to the family.

[Chris Pine]

None of these surgeons hailed from historically elite universities or hospitals. As had been the case for the last decade and a half, the real innovation in cardiac surgery was happening on the margins of the field. For much of the world, the heart remained mythically tied to the soul. And the promise of a heart transplant tapped into our wildest dreams and deepest fears. Whichever surgeon crossed the finish line first, be it Shumway, Lauer, Cantrowitz, or Hardy, he could expect to receive both sweeping adoration and rebuke. Less than two weeks after Shumway's announcement, A shocking news story broke in Cape town, South Africa.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

We had a recipient reading. We had the donor identified in Philadelphia, as a matter of fact, and that morning my daughter came in and said some Joker down in Africa has done a heart transplant. On December 3, 1967, Christian Barnard removed.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

The heart from a 25 year old.

[Jamie Napoli]

Girl and transplanted into the chest of a 55 year old man.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

In case you missed the news that.

[Jamie Napoli]

Day, performed by a surgeon virtually unknown.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Except to a handful of other surgeons.

[Adam Barnard]

Newspapers everywhere carry banner headlines and from medical men as far away as the.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Soviet Union, there is a claim for the dramatic breakthrough.

[Jamie Napoli]

Will you welcome Dr. Christian Barnard.

[Chris Pine]

The heart transplant race had just been won by a man who wasn't even considered a contender in a country no one regarded for its medical prowess. How could this happen? And who the hell was Christian Barnard? The world was about to find out. From OSO Studios, this is Cardiac Cowboys, a podcast about life, death and innovation in the American Heartland. Episode 4 the Transplant Race here's writer and executive producer Jamie Napoli.

[Jamie Napoli]

For all the criticism that would be hurled at Christian Barnard throughout his career, and there would be plenty, one thing is certain, he fought tooth and nail for every success that came his way. Unlike his American counterparts, Barnard was born into poverty. His family lived in a small town within South Africa's Great Karoo, a harsh semi desert region stretching hundreds of miles between Cape Town and Johannesburg.

[Adam Barnard]

It's a hellhole of a place, I can tell you. Terrible place, a very country small little garuta in the back of equivalent, Nevada or Arizona.

[Jamie Napoli]

Adam Barnard is the son of Christian's youngest brother Marius.

[Adam Barnard]

A lot of people in life who get to invent certain things, you tend to find quite a lot of them have come from those humble beginnings. And the Barnard brothers were very fortunate to have very humble, peaceful, God loving parents.

[Jamie Napoli]

Christian Barnard's father was a minister who preached both at the local jail and at the Dutch Reformed Church designated for the town's black and mixed race population. As a result, the Barnards, who were white, were shunned by their white neighbors. And the Barnard children would grow into fierce critics of apartheid.

[Cindy Ladigan]

Chris didn't grow up in a household that entertained apartheid.

[Jamie Napoli]

That's Cindy Ladigan, manager of the Heart of Cape Town Museum when he brought.

[Cindy Ladigan]

Intensive care to South Africa where the rest of the hospital would lay divided. Even the ER itself had a different entrance for white folk. He had all his patients laying together and he had this attitude of if you didn't like it, you could go die at home.

[Jamie Napoli]

Christian Barnard had three living Johann, Dodsley and Marius. A fourth brother named Abraham had died at the age of three from a congenital heart defect. Abraham's death loomed over the Barnard children in the form of their mother's grief.

[Cindy Ladigan]

She became a very hard woman after the loss of Abraham. They were all terrified of the mother. She always pushed him to be first. Always. And if they didn't come first, they'd be whipped.

[Jamie Napoli]

Christian Barnard spent his life racing to be first, regardless of the obstacles that lay ahead of him. As a child, he competed in his town's annual foot race without shoes. He won his school's tennis championship playing with a borrowed racket. And he patched together scholarships to put himself through medical school, leaving no money to buy clothes or to socialize with his classmates. As a young doctor at Ruth d' Escuar hospital in Cape Town, he quickly set himself apart with his pioneering research in the field of gastrointestinal surgery.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

He did seminal work on an operation to deal with intestinal atresia, which is a potentially lethal defect.

[Jamie Napoli]

That's medical historian and plastic surgeon Dr. Gerald Imber. In 1955, Barnard's research caught the interest of an American surgical chief 9,000 miles away.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Barnard earned his way to study with the great Owen Wangenstein in Minnesota.

[Jamie Napoli]

He said goodbye to his wife, Loki, and their two young children with a vague promise that they'd join him in America at some point in the future. A tall, lanky country boy with a mop of unruly brown hair, Barnard looked younger than his 33 years. As he left behind beautiful Cape Town, he was filled with visions of a future that until this moment, had been unimaginable to him or anyone in his family line of destitute ministers and woodcutters. When Barnard arrived in Minneapolis on a late December night, thousands of miles from the nearest friends or family, the temperature hovered just just below zero.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

In addition to freezing his butt off, what he found out was that Wangenstein didn't want to teach him clinical surgery. He wanted him working on projects in the lab because he had great lab credentials.

[Cindy Ladigan]

Wagonstein was extremely impressed with the amount of drive that this guy had. Chris actually did his PhD in two years, where it would normally take six years to accomplish.

[Jamie Napoli]

Barnard joked that he only slept on Sundays when he was kicked out of the lab. And that may not have been far from the truth. To fund his family's eventual move to Minneapolis, he supplemented his hospital income with odd jobs around town, Shoveling snow in the winter, washing cars, and taking night nurse shifts for wealthy patients. At the University of Minnesota, Barnard developed a reputation not just for his obsessive work ethic, but for the brash, confident charm that masked insecurities about his finances and his foreignness. It Made him popular with senior surgeons and administrators like Owen Wongenstein. Less so with his peers. Here's Christian Barnard's nephew Adam Barnard Again.

[Adam Barnard]

He was very careful, charismatic. He had a good looking toothy smile. He could make you feel a million dollars in two seconds. But he could also make you feel the biggest fool in two seconds.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Chris Barnard was beloved by everybody who didn't know him and not by anyone who did.

[Jamie Napoli]

But Barnard hadn't left behind his family and flown halfway around the world to make friends. He was there to make a name for himself. Early in his residency, Barnard's ambition came into sharp focus when he was introduced to the heart surgeons down the hall. He began observing open heart operations from the upper level of the glass domed or down below, Walt Lillehei was repairing cases of tetralogy of Fallot, the condition that had taken the life of Barnard's three year old brother Abraham. As he watched Lillehy and his ingenious bubble oxygenator save a dying child, Barnard sensed that this was the work he was meant to be doing. It wasn't long before he asked Wonenstein to be transferred to cardiac surgery. By now Lillehy was already a legend within the department, inventing new life saving procedures on a monthly basis. Barnard worked tirelessly to impress him, studying the bubble oxygenation and assisting in operations until he was promoted to Lillehgh's chief resident. It was then that he made the first catastrophic mistake of his young career.

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[Jamie Napoli]

In his autobiography One Life, Barnard details exactly what went wrong as he was prepping a seven year old patient for open heart surgery. As the boy's anxious father watched from above, Barnard and his assistant accidentally sliced into the exposed heart. Blood erupted from the boy's heart and filled his open chest cavity. Barnard panicked. He struggled to staunch the bleeding, but he couldn't locate the hole in the rising pool of blood. By the time Lillehy arrived to help, the boy was dead. Above them, on the operating theater's upper level, the boy's father had seen it all. Barnard wandered aimlessly through the hospital before finally dragging himself to Lillehy's office. He didn't know whether the senior surgeon would chew him out or fire him. Look, Chris, Lillehy said calmly, we've all made these mistakes that cost the lives of patients. The only thing you can do is to learn by your mistake. Lillehy tasked Barnard with prepping another young patient for surgery the following day. Rather than hovering behind him, Lillehy remained absent from the OR until the last possible moment to show that Barnard had retained his full confidence. This early surgery was going to be fraught with trouble, and dad knew that. That's Walt Lillehei's son, Dr. Craig Lillehei. What he realized is good judgment comes from experience and experience comes from bad judgment. It was clearly something they embraced in those early days that it was okay, this didn't work. We've got to figure out how we can try to solve it next. Lillehgh valued ingenuity and work ethic far above technical prowess, which favored Barnard, whose surgical ability didn't always measure up to that of his colleagues. One such colleague was a young surgical resident who would one day lead the heart transplant race, Norm Shumway. Compared to the charming and outwardly ambitious South African, Shumway was self deprecating and low key.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Dad always felt that in academic medicine people took themselves too seriously.

[Jamie Napoli]

That's norm Shumway's daughter, Dr. Sarah Shumway. She's a surgeon at the U of M who specializes in heart and lung transplants.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

He told me when I started in my own operating room to keep things light so people didn't get too overwhelmed by the fact they were cutting out people's hearts.

[Jamie Napoli]

Within a decade, Christian Barnard and Norm Shumway would become the two biggest names in heart transplantation and their work would define the future of cardiac surgery. For now, they were lowly U of M residents whose personalities didn't always mesh.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I think they were cordial, but they weren't really friends. Shumway thought he was a self serving bit of a jerk and wanted nothing to do with them.

[Jamie Napoli]

While Shumway struggled to stand out among many ambitious surgical residents, Barnard had grown into the department's golden boy. As his residency came to an end, Wongenstein begged Barnard to stay in Minnesota, offering him a position with the U of M faculty. Though Barnard turned down the offer, Wongenstein sent him back to Cape Town with a life changing gift. Here's an archival recording of Dr.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Norm Shamway when he went back to South Africa. Wangenstein, such a generous man, gave Barnard $10,000 for cardiopulmonary bypass equipment, so he had substantial back.

[Jamie Napoli]

Rutteskuur is a large, picturesque hospital nestled into the base of the precipitous Devil's Peak, which overlooks cape town. In 1958, Barnard rejoined the faculty as a returning hero. He'd studied with the greatest heart surgeons in the world, and thanks to Wangenstein, he brought back with him the famous Dawah Lillehai bubble oxygenator. Now he was setting out to bring South Africa into the era of open heart surgery. Like his mentor, Walt Lillehei, Barnard had his own ticking clock. In the frigid Minnesota climate, he'd begun experiencing crippling flashes of pain, first in the joints of his feet, later in his hands. He was diagnosed with rheumatoid arthritis, an excruciating autoimmune disease. Barnard tried all kinds of traditional and non traditional medicines, everything from guava to brake fluid. But rheumatoid arthritis has no cure. For the rest of his career, he'd live in fear that the pain and deformity in his hands would grow so advanced that he'd no longer be able to operate. If he was going to leave his mark on the field of cardiac surgery, Christian Barnard would have to do it quickly. Barnard's mission crystallized after he learned of a breakthrough experiment performed at Stanford University by an old colleague, Dr. Norm Shumway. After finishing his residency in Minnesota, Shumway had spent years struggling to find his footing. First in Santa Barbara, then in in San Francisco. As he labored to support his young family. No job was too small, from working night shifts operating an artificial kidney machine to performing simple open heart operations at a hospital across town. Anytime Shumway was referred a patient for surgery, he and his partner, Richard Lauer, would pack their heart, lung machine and other equipment into a moving van and brave San Francisco traffic to get from their Stanford Lane laboratory to the ORs at the children's Hospital. When Stanford's medical school relocated to Palo Alto In 1959, Shumway was asked to take over the Department of Cardiac Surgery. Thrust Into a leadership role for the first time. Shumway excelled. His management approach was as low key as his personality. He liked to describe himself as the world's greatest first assistant. Here's an archival recording of one of Shumway's chief residents, Dr. Jack Copeland. He used to say that when you go to Houston, you think that Denton Cooley is the only one that can operate because he's the only one that was operating. When you go to Stanford, you think.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

That anybody can operate because we were.

[Jamie Napoli]

In there doing all the cases and he was helping us. In December, Shemue's team performed the first heart transplant in a lab dog, Proving to surgeons the world over that human heart transplantation was within reach. The greatest obstacle to getting there was the lack of a viable donor. The ideal heart for transplantation is still beating up until the instant it's removed from from the donor. The problem was that up until this moment in history, a beating heart meant that the donor was still alive. Before a human heart transplant could occur, Shumway and his colleagues would need to convince the world that death could be defined as the loss of brain function, not just the stopping of the heart.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

I used to call it the boy scout definition of death.

[Jamie Napoli]

That's Dr. Norm Shumway again.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Even our neurosurgeons were very slow to come to grips with brain death. That philosophy or misjudgment or lack of education, tradition, whatever you want to call it, was very slow. This was a difficult problem.

[Jamie Napoli]

Doctors and administrators alike feared that removing the heart of a brain dead patient might result in a murder charge against the surgeon. And not without reason. Norm Shumway would be threatened with such charges in the years to come. The other problem looming over the dream of a human heart transplant was organ rejection.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Some animals would live two or three weeks, Others would die in a few days because of rejection. The heart transplant is such a bigger procedure and the preparation is so doggone fragile and delicate that when we use the same menu of immunosuppression that others were using in kidney transplants, our animals would all die of toxicity.

[Jamie Napoli]

Norm Shumway and Richard Lauer spent years working out the rejection problem, Devising a precise cocktail of steroids and immunosuppressants to give transplant recipients the greatest probability of accepting their new hearts. Facing the same problem, Christian Barnard took a different approach. In the summer of 1967, he made a trip to Richmond, Virginia, where Richard Lauer was working. At the time, the medical college of Virginia was renowned for its kidney transplantation program, and that's the reason Barnard gave for his visit. He was preparing to transplant a kidney, he said. But while he was there, he, Lauer happily showed him the immunosuppression techniques he and Shemway had developed for a heart transplant.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

He'd go down to the lab and see Lauer doing these heart transplants with the same facility and success he'd had at Stanford. Barnard had one of his technicians with him on this trip, and the technician told Lauer, he said, you know, Barnard's gonna go home and do that operation. And Lauer just shrugged it off. And it's ridiculous.

[Jamie Napoli]

And yet Barnard set out to do exactly that. Here's Cindy Ladigan again.

[Cindy Ladigan]

He had watched Richard Lower practice and experiment on dogs on that side. So he had to come back and teach the side here. Everything that he'd seen, everything that he'd learned.

[Jamie Napoli]

Barnard had spent the last several years assembling an elite cardiac surgery team in Cape Town. His most trusted confidant was a young vascular surgeon named Marius Barnard, Christian's younger brother.

[Adam Barnard]

My father never wanted to do heart surgery and he never wanted to work with Chris.

[Jamie Napoli]

That's Marius son, Adam Barnard.

[Adam Barnard]

Again, you know, brothers, they're competitive and they can be very brutally honest with each other.

[Jamie Napoli]

Prior to joining his brother's team, Marius had spent a year in Houston training under Baylor's demanding surgical chief, Michael DeBakey.

[Adam Barnard]

When he worked under Debakey, he didn't really learn a lot because DeBakey just wanted to control all operations and didn't want anyone else to operate. He liked Denton Cooley. He learned a lot from him. But obviously, surgeons, they all got a huge ego and they all think they're the best. Denton Cooley used to say, just call me God, which stands for good old Denton.

[Jamie Napoli]

Christian. And Marius Barnard employed many of the techniques they'd picked up in the US from Walt Lillehei, Michael DeBakey, Denton Cooley, Richard Lauer, and Norm Shumway. Together, the brothers performed dozens of heart transplants on lab dogs as they prepared for their first human patient in the fall of 1967, Christian Barnard found himself in the same position as Norm Shamway, ready to transplant but waiting on the right patient and donor. That's when a cardiologist introduced him to a Cape Town grocer named Louis Wishkanski. Here's Heart of Cape Town museum manager Cindy Ladigan.

[Cindy Ladigan]

Again, Louis had heart failure. He had had two heart attacks prior to this, and he was actually admitted to Groote Skier Hospital purely because he was in such a bad state.

[Jamie Napoli]

In his youth, Louis had been a powerful amateur boxer. Now in his 50s, his heart failing, he was using all his strength to fight for survival. Louis had already outlived lived his prognosis by two years when Barnard met him. In addition to heart disease, he suffered from diabetes, liver failure, kidney failure and a host of other serious ailments. Without an immediate heart transplant, Louis didn't have long to live. Thankfully, while Shumway and the other American surgeons were still struggling to garner widespread acceptance for the concept of brain death, Barnard's job was easier.

[Cindy Ladigan]

What was the upper hand for Chris to actually be the first here was the declaration of death. In South Africa, medical law stated that you needed two doctors to do a death declaration. America was way stricter.

[Jamie Napoli]

Barnard didn't need to change anyone's mind about the definition of death. All he needed was a brain dead body patient with a matching blood type. He wouldn't need to wait long.

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[Jamie Napoli]

On December 2nd, the Darvall family stopped outside a bakery in the Salt river suburb of Cape Town. 25 year old Denise and her mother ran inside to get a cake. Denise's brother Keith and their father Edward waited in the car. As the Darval women made their way back to the car, a drunk driver careened down the street toward them.

[Cindy Ladigan]

Denise was flung 40ft in the air. She hit her head on the back of a vehicle and she fractured her skull in two areas. Her mum passed away at the scene.

[Jamie Napoli]

Louis Wishkansky's wife Ann was leaving the hospital when she drove by the Scene of the accident as police waved her on, she could make out two women lying in the road. Christian Barnard was at home when he got the call. There was a young woman at the hospital who'd suffered severe brain damage. It was possible her heart might serve as a viable replacement for Louis Wishkansky's.

[Cindy Ladigan]

One can only imagine what her father, Edward, must have felt like knowing that his wife had passed away. Sitting at the hospital, it's 10 o' clock at night. He's hoping for some kind of conflict, good news about his daughter. And these doctors come out and say to him that there isn't any, that he needs to accept the fact that his daughter's gone. But while she's on life support, she could help this patient in the hospital, Louis Washkansky.

[Jamie Napoli]

Edward Darval would later recount that in that moment he remembered how Denise had spent the first paycheck she ever made on a gift for him. She was always going giving away things to other people, he'd say. Giving would be her legacy.

[Cindy Ladigan]

They say. He took four minutes to think about it and his first words were, if you cannot save the life of my daughter, then you need to save the life of that man. We do consider Edward Deval a hero because he had a heart of no other.

[Jamie Napoli]

Christian Barnard arrived at the hospital ready to save Louis Wyszkansky. Denise was examined by the senior neurosurgeon at the Rue d' Escur and declared brain dead. She was relocated to one of two adjacent ORS B theater. Louis Wyszkansky was moved to a theater.

[Adam Barnard]

The Americans and the French and in most European countries at the time, they had much better cardiac facilities than they had in South Africa. So it came down to the theater nurses, the anesthetists, you name it. Every single little aspect of that had to be right.

[Cindy Ladigan]

There was no room for error. That's the type of person Chris was. In the workplace, it was all or nothing.

[Jamie Napoli]

Initially, the plan was for Marius Barnard to remove Denise's heart and for Christian to transplant it. But Marius suggested a last minute change. Unless you cut it out yourself, he told his older brother, it's not going to be familiar. It's better you get acquainted with it from the beginning. Christian Barnard dashed madly between the two operating theaters as donor and recipient were prepped for surgery in a theater. Washkansky's chest was sliced open, his sternum was sawed down the middle and his ribs were cranked apart with a retractor. The beating organ that lay inside was enlarged and scarred beyond recognition. Barnard described it as the waste and ruin of a ravaged heart. In b theater, Marius Barnard turned off Denise's respirator. Despite the comparatively lax medical definition of death in South Africa, this team wasn't taking any chances. They wish waited as Denise's heart began to fail. The moment it stopped beating, Christian Barnard called out, start cutting. And then he scrubbed up for surgery. With her chest spread open, Christian Barnard finally got his first look at Denise's heart. It was tiny, but it would have to do. Painstakingly, Barnard severed the eight blood vessels leading into and out of Denise's heart. When the heart was finally liberated from her body, Barnard placed it in a metal basin. And then he carried it slowly and carefully to a theater. Denise's heart looked absurdly small inside Louis massive chest. Barnard had to trim her blood vessels at an angle to match their wide counterparts in Louis body. His hands ached, but he ignored the pain. This was the moment his entire life had been racing toward. The moment that would determine whether Louis Wishkansky lived or died. And whether Christian Barnard went down in history or became a mere footnote in someone else's story. Blood vessel by blood vessel, he began to suture Louis new heart into place.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

When I left the hospital that morning, it was summer and the sun was just rising. There was not one photographer, not one television camera, not one reporter outside that hospital.

[Jamie Napoli]

That's an archival recording of Dr. Christian Barnard.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I said to my brother who was with me, I said, you know, we better tell someone in the hospital that we've done a heart transplant tonight.

[Jamie Napoli]

The brothers moment of quietude wouldn't last for long.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Heart transplant at Good Shaw Hospital in Cape Town.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Medical history has been made in South Africa.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

The world's first heart transplant patients. Lou Washkansky continues to improve.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I had phone calls from all over the world and that evening there was a television crew here. And then after that, it just became impossible to work. I don't think they recognizes the need that I had to look after my patients and that I couldn't spend all the time answering questions and appearing in front of cameras.

[Jamie Napoli]

When news of the transplant reached doctors in the United States, there was an immediate shock, followed by frustration. Here's Dr. Adrian Cantrowicz again.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I must say I was disappointed because we were all set to go. It was just a matter of luck who got the donor and recipient together first.

[Jamie Napoli]

Denton Cooley, though he hadn't yet attempted any test transplants of his own, sent Barnard a playful telegram that read, congratulations on your first heart transplant, Chris. I will soon be doing my 100th. There was a sentiment shared by many American surgeons that Christian Barnard did not deserve to be first, that he'd benefited from the hard work of others. Barnard fought back against these accusations vehemently.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

It really amazed me very much. I was present at meetings where senior surgeons got up and, and stated that I stole the technique from Shumway and that I should never have been the first one to do the transplant. Well, you know, I mean there's no such thing as a single genius. We get ideas from everybody.

[Jamie Napoli]

Of all the Americans, Norm Shumway had perhaps the most valid reason for begrudging Barnard. But by all accounts he didn't.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Dad seemed to be quite excited that a transplant had been performed. I'm sure he was disappointed not to have been the first one, but I think that wasn't the prize he was after. What Barnard did really was to establish that brain death was an acceptable definition of death.

[Jamie Napoli]

Barnard's operation had set a precedent. And while the concept of brain death would remain divisive for years to come, American surgeons felt emboldened to attempt transplant operations of their own. In the second week after Barnard's historic first, Louis Wishkansky's health took a turn for the worse. He'd picked up a bacterial infection in the hospital and the abundance of immunosuppressants in his body, the anti rejection drugs Barnard had given him made it impossible for him to fight it off. On December 21st, Louis became the first man, man in history to die after someone else's heart stopped beating in his chest.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I was completely destroyed that morning I went down to my office and I lay on the couch there and one of my laboratory assistants came in and he saw I was crying because he was a very likable man, Mr. Waskanski. He was a very nice man. It was great sorrow that we let him down.

[Chris Pine]

Foreign.

[Jamie Napoli]

Washkansky's death did little to slow the transplant fever that was spreading rapidly around the world. Barnard already had his second heart transplant operation on the books. His face had appeared on the covers of Time and Life magazine. And his days in the spotlight were just beginning.

[Adam Barnard]

He literally became more than likely one of the most famous people on the planet for two, three years.

[Jamie Napoli]

That's Adam Barnard again.

[Adam Barnard]

He met Johnson, the President of the United States. He met the Queen. He met the Pope. Not many people do that in the space of a year. It's very easy for it to go to your head.

[Jamie Napoli]

The Guinness Book of World Records stated that Barnard received more fan mail than anyone in the history of the world. He was even the subject of a hit Dutch pop song by Bonnie Sinclair. The swell of celebrity enveloping him was all consuming, and yet there was still plenty to go around. Fame and fortune awaited any surgeon with the audacity to pull off a heart transplant.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

There was enormous media response even for the second and third and fourth heart transplants. And there were television programs night talking about heart transplants. And pretty soon it got to be that if you didn't do a heart transplant, you weren't a real heart surgeon. And so therefore everybody who wanted to be a real heart surgeon started to do it, including some very real heart surgeons like Mike DeBakey and like Denton Cooley.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

You feel like that you're something like an astronaut, you know.

[Jamie Napoli]

That's an archival recording of Dr. Cooley, who leapt headlong into the heart transplant arena. By September of 1968, he'd performed 10 transplant operations.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

The astronaut gets all the credit and he gets the trip to the moon. But he had nothing to do with the creation of the rocket or all of the navigational problems. In those early events, we were, I think, glorified beyond reason.

[Adam Barnard]

Who did the first kidney transplant? Do you know? No. But everyone knows who did the first heart transplant. Over the years, the seat of religion, the seat of love, the seat of compassion is your heart. That's why it was such a big deal at the time.

[Jamie Napoli]

For patients living with the death sentence of failing hearts, the birth of heart transplantation offered new hope.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

I feel so much better than I have for 25 years.

[Jamie Napoli]

That's a recording of Cooley's first heart transplant recipient, Everett Thomas.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

I was getting worse and worse week and week. Now I'm getting stronger and stronger as day goes on.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I feel exactly the same way I.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Did when I was a young boy.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

At 19, 20 years old.

[Jamie Napoli]

Even as successful heart transplants were being performed by surgeons all around the world, the public remained fascinated by the man who did it first. Who is this man who has twice.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

Played God, who is greeted like a Hollywood idol, who is adored by his subordinates, who moves with boyish charm among the many races of his native land? The world wants to know who is Dr. Christian Nling Barnard?

[Adam Barnard]

Fame is quite a lethal drug. My father used to say that the worst drug in the world is somebody claps hands at you because it goes to your head, you know. That did unfortunately get to my uncle. Everyone wanted a piece of him.

[Cindy Ladigan]

He met the likes of Princess Diana, Grace Kelly, Sophia Loren. He loved the ladies. That is undeniable. His wife actually said, you know that he should never have gotten married or had children because he didn't belong to a wife or a home. He belonged to the world.

[Jamie Napoli]

Newspapers breathlessly covered Barnard's romantic dalliances with Gina Lolobrigida, Sophia Loren, a former Miss Italy and Miss South Africa. Within a year and a half of the first transplant, Barnard's wife Loki had filed for divorce. Marius Barnard took over much of the department's workload as his older brother brother balanced a surgical schedule with life as a full time celebrity.

[Narrator/Various Doctors (e.g., Dr. Adrian Cantrowitz, Dr. J. Phillips Saul)]

I was just a Ordney doctor. All of a sudden it was big news, you know, that I had an affair with a scout. So people often criticized me for, for what I did. But they must remember that I would never prepare for the situation I was putting over.

[Jamie Napoli]

Months into the rise of transplant fever. The fever broke. Patients began dying at an alarming rate. Just as quickly as the public had embraced heart transplantation as the future, they turned on it as well as the doctors leading the charge.

[Adam Barnard]

At first, it was no more than a murmur.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

Today it can be heard around the world. Heart swapping is direct killing.

[Jamie Napoli]

Here's Denton Cooley again.

[Archival Recordings (e.g., Dr. Norm Shumway, Dr. Denton Cooley)]

I think we did 12 consecutive ones and we had about nine living recipients. Then the attrition began. Within 18 months, all of the patients had died.

[Cindy Ladigan]

Chris had letters of congratulations and a lot of letters of hate. People that were asking for his earlier race because he should be had up for murder. People that said he was unmoral and a bunch of Ghouls.

[Jamie Napoli]

A 1971 issue of Life magazine ran with the COVID story a new report on an era of medical failure. The tragic record of heart transplants. Doctors and politicians alike called for an end to the procedure. The careers of transplant survivors, surgeons and the lives of their dying patients were suddenly under threat. The future of the field would depend on what these surgeons did next.

[Chris Pine]

On our next episode, an ingenious medical device promises to eliminate the need for heart donors entirely. And the competition between Houston surgeons Michael DeBakey and Denton Cooley explodes into an all out feud playing out in courtrooms and headlines across the country. Next time on Cardiac Cowboys.

[Jamie Napoli]

Cardiac Cowboys is a production of iHeart podcasts, OSO Studio and 13th Lake Media. We're presented by Chris Pine and written and narrated by me, Jamie Napoli. Our executive producers are Christina Everett for iHeart Podcasts, Dub Cornette and Jason Ross for OSO Studios. Dr. Gerald Imber, author of Cardiac the Heroic Invention of heart surgery, Dr. Eric A. Rose, John Mankiewicz, Joshua Paul Johnson and myself. James A. Smith is our supervising producer, editing and sound design by Joshua Paul Johnson. Our composer is David Mansfield. Our cover artwork is designed by Alexander Smith. For more information on the first cardiac surgeons, check out Dr. Gerald Imber's book, Cardiac the Heroic Invention of Heart Surgery.